PAT I E N T I N F O R M AT I O N
Frequently Asked Questions
Question:
Answer:
Is the eight-Plate meant to be permanent?
No, it should be removed when the deformity is corrected.
Question:
Answer:
How long can the eight-Plate safely be left in place?
As long as it is required, pending correction of the
deformity. The typical range is 6 -18 months.
Question:
Answer:
What are the indications for eight-Plate application?
Any angular deformity that would otherwise warrant an
osteotomy in a patient with open growth plates, or any
length discrepancy that would otherwise merit
epiphysiodesis.
Question:
Answer:
Is a cast required after eight-Plate application?
No cast is required.
Question:
Answer:
Can the patient go home on the day of surgery?
Yes, generally patients go home after surgery on the same day.
Question:
Answer:
Are there any limitations or precautions in terms of weight-bearing?
Typically patients are encouraged to carry out immediate
weight-bearing and early motion as advised by their doctor.
Question:
Answer:
How often does the patient have to come back for a check-up?
Patients should be seen at least every 3 months to monitor their growth
and determine when to remove the plate.
Question:
Answer:
Are there any contraindications to the eight-Plate?
The eight-Plate should not be used for adult deformities (when the
growth plates have closed) or where the growth plate has closed,
such as due to trauma or infection.
Question:
What is the recommended age and/or size for a patient to have an
eight-Plate implant?
Since the eight-Plate does not bear any body weight after it is implanted,
patient size really doesn’t matter. The eight-Plate can be used successfully
in patients as young as 18 months or as old as 17 years, as long as the
child is still growing (skeletally immature).
Answer:
Question:
Answer:
Is the use of the eight-Plate limited to knock knees and bowed legs?
No, it may be used to correct other angular deformities such as flexion
or extension deformities of the knee; valgus, extension or flexion
deformities of the ankle; varus deformity of the elbow; and wrist
flexion/extension deformities or radial/ulnar deviation.
w w w. o r t h o f i x . c o m
EP-1302 PL-US © Orthofix Holdings, Inc. 3/2013
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Gentle Guided Growth
to Correct Knock Knees
and Bowed Legs
in Children
The Guided Growth™System
eight-Plate®
quad-Plate™
Introduction
Children need gentle guidance and correction in many aspects
of their life. For a significant number of children who do not
spontaneously grow out of “bowed legs” or “knock knees,” pain
and/or difficulty in running may ensue. These children can benefit
from a new, minimally invasive surgical procedure that involves
the insertion of a small device called the eight-Plate.™ The
eight-Plate gently guides growth while allowing natural, safe
and gradual correction of limb alignment. Growing up is
tough enough on both children and their parents! Using the
eight-Plate, your surgeon can accurately and selectively correct
limb deformities so that your child can get on with growing
up-strong and straight. Read on for more information about
the correction of limb deformities using the eight-Plate and
a procedure referred to as hemi-epiphysiodesis.
Knock Knees and Bowed Legs
In normal skeletal growth, limbs are equal in length
and are properly aligned from the hips to the
ankles. Sometimes, however, congenital
abnormalities, infection, injury or other
conditions can cause long bones of the
leg (e.g., tibia, femur) to grow out of
alignment.
This misalignment often may result in
joint deformities of the leg known as valgus
(knock knees) or varus (bowed legs) deformities.
In these situations, normal use of the leg is impaired
and walking or running may be painful.
Unfortunately, bracing is not
effective in the management of these
conditions. The correction of limb
deformities requires one of two
surgical procedures: either an
osteotomy [os-te-ot o-me] or the
minimally invasive hemi-epiphysiodesis
[hemi-ep-i fiz-e-o-de sis] procedure.
Corrective Surgical Procedures
Correction using the osteotomy
method is a significant surgical
procedure that involves cutting the
misaligned bone, adding or removing
a wedge of bone (depending on the
type of deformity) and realigning the
bone. The realigned bone must be
fixed into place with pins or with a
plate and screw combination followed
by a cast. Another alternative is to fix
the realigned bone in place using pins
in the bone segments and connecting
them to an external frame. In addition
to the inherent risks of such a surgery,
the child must endure a prolonged
hospital stay and delayed weight bearing,
followed by a course of physical therapy.
In many cases, multiple osteotomy
surgeries may be necessary to fully
correct the leg’s alignment.
epiphysiodesis - an operation
to stop the activity of a growth
plate. The effects can be
permanent or temporary
hemi-epiphysiodesis - to
tether or restrain one side
(medial or lateral) of the
growth plate with an implant
femur - the long bone
of the thigh
tibia - the larger leg bone
between the knee and ankle
(shin)
normal alignment - younger
children should be able to
stand with the knees and
ankles touching simultaneously
valgus - an inward angulation
of the knee in which the ankles
are separated while the knees
are touching; “knock knees”
varus - an outward angulation
of the knee in which the knees
are separated while the ankles
are touching; “bowed legs”
osteotomy - cutting a bone
into two segments
In contrast, correction using hemi-epiphysiodesis is a much less invasive
surgical method for correcting pathological angular deformities.
Epiphysiodesis is a term from the Greek in which “physis” means
growth plate and “desis” means tether. This procedure, traditionally
known as “epiphyseal stapling” utilizes surgical staples (typically 2
or 3) on one side of the physis, restricting its growth while permitting
continued growth on the opposite, non-instrumented side. The goal is
to permit realignment through growth. More simply put, bone growth
is restricted on one side of the deformity while bone growth continues
on the other side. Gradually, the bone realigns and the deformity is
corrected. Since the bone is not cut (as with an osteotomy), there is
no neurovascular risk, instability from the cut, or significant period
of healing.
physis - growth plate near
either end of the long bones
(femur and tibia) which allows
for elongation. These close
naturally at maturity (girls
at age 14, boys at age 16
approximately)
implant - device inserted
into a tissue for a specified
period of time which is not
absorbed by the body
Lateral
Side
Implant
Medial
Side
lateral - outer side, away
from the middle or median
plane
medial - inner side near
the midline
Correction Through Guided Growth
Using the Orthofix eight-Plate
The new eight-Plate technique of guided growth overcomes the
drawbacks associated with traditional stapling and can give your
child improved correction of his or her angular deformity.
Femur
Physis
(growth
plate)
Despite the fact that epiphyseal stapling has been used with success
for more than 50 years, there are drawbacks and limitations to the use
of staples. Staples are rigid, U-shaped implants that allow no flexibility
during the growth and realignment of the bone. Additionally, the
staples compress the growth plate on one side. Surgical planning for
the precise placement of the staples is complicated. Furthermore, when
rigid implants such as staples are confronted by the powerful forces
generated by physis (growth), the staples may migrate, bend or break
and compromise the outcome. Staple retrieval or revision may prove
difficult, resulting in inadequate correction (or overcorrection) of the
deformity.
Tibia
The Orthofix eight-Plate or ‘guided growth plate’ is a unique,
figure-eight shaped device about the size of a paper clip, that allows
gradual correction of your child’s limb deformity. The eight-Plate
holds one side of the growth plate. As the opposite side of the physis
continues to expand and grow, the screws diverge within the plate,
effectively serving as a hinge. This hinge action also avoids compressing
the growth plate that is being guided. And because of its flexibility, the
chances of the plate or screws bending or breaking under the forces
of bone growth are considered very low.
The Surgical Procedure
Correction Occurs Gently Over Time
Implantation of the eight-Plate is performed under anesthesia and takes
about an hour. During the procedure, the surgeon will make a 2-3 cm
(approximately 1”) incision at the physis of the bone to be corrected.
The eight-Plate is secured to the bone with two small titanium alloy screws.
For “knock knees” the eight-Plate is placed on the medial side of the bone
(i.e., inner side); for bowed legs, the eight-Plate is placed on the lateral side
of the bone (i.e., outer side). Multiple deformities can be addressed during
the same procedure, inserting one eight-Plate per physis. The incision is
closed, generally with resorbable sutures. After recovery from anesthesia,
your child may be taken home.
The eight-Plate temporarily restrains growth on one side of the bone plate
while natural growth is allowed to continue on the opposite side. Gradually
over time, (typically from several months up to one year) the deformity is
corrected. To ensure timely and adequate correction, your child needs to be
seen by the surgeon every 3 months for a check-up. If your child cannot return
to the surgeon every 3 months, due to distance for example, another doctor
should take x-rays of the legs. The most accurate film is a full-length view taken
in the standing position. Send these x-rays to the surgeon who implanted
the eight-Plate. When the deformity is corrected, the surgeon will remove the
eight-Plate under anesthesia in an outpatient surgery.
Postoperative Recovery
The eight-Plate technique of guided growth involves minimal surgical trauma
and pain when compared to an osteotomy. There is no cast; crutches are
optional (for comfort) and physical therapy is seldom required. Your child
is encouraged to walk and resume activities as tolerated, including sports
when comfort permits, which is typically within 3 weeks.
Trevan, who has a hereditary skeletal
dysplasia, presented at age 2 with short
stature, waddling gait and activity-related
hip and knee pain. He received eight-Plate
guided growth treatment, and at one year
his legs had straightened and his symptoms
were resolved. The eight-Plate has allowed
Trevan to receive treatment at an earlier
age, and his deformities were corrected
without major surgeries, without
osteotomy and without hospital stays or
casting. He is now enjoying a normal,
active childhood.
at time of surgery
several months up to one year
Sometimes, our children need a little extra correction. And if that correction is
needed for a joint deformity, rest assured that you and your child are not alone.
We understand that surgery on our little ones is traumatic for you and the child,
but consistent correction and gratifying clinical results have been achieved with
guided growth using the eight-Plate.
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